Provider Demographics
NPI:1790546588
Name:MCRAE, JASHEEM
Entity Type:Individual
Prefix:
First Name:JASHEEM
Middle Name:
Last Name:MCRAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14823 HAYMARKET LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1869
Mailing Address - Country:US
Mailing Address - Phone:703-231-3818
Mailing Address - Fax:
Practice Address - Street 1:14823 HAYMARKET LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1869
Practice Address - Country:US
Practice Address - Phone:703-231-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty